Custom-made Ocular Prosthesis for Rehabilitation of Missing Parts of the Face: A Case Report

Background. Eyes are an important component of the face and vital organs of vision. Eye loss can be caused by congenital defects, trauma, or tumor. Loss of an eye produces physical abnormalities that pose a psychological burden on the patient, as well as visual function damage. An ocular prosthesis is an artificial maxillofacial prosthesis to replace the lost eye. Case summary. A 54-year-old man consults at the Prosthodontics Specialist Universitas Airlangga Dental Hospital for an eye prosthesis. The patient did not have the right eyeball since birth. Soft tissue around the eye is normal, including the palpebral muscles. Case management. An impression was made using a custom tray and alginate in the defect area, followed by filling the impression with gypsum type 3 to get a working model, from which a wax model is made and adjusted to the patient. After that, sclera and ocular acrylic prostheses are made on the basis of an adjusted wax model. The prosthesis is then polished and colored according to the contralateral eye. Then the prosthesis is delivered to the patient. Conclusion. The hollow custom-made eye prosthesis can be considered in the treatment of anophthalmia. It is able to improve the patient's psychological and emotional status.

Features of the acid-base balance of the prosthetic cavity in patients with diabetes mellitus

The number of patients with diabetes mellitus in the Russian Federation on January 1, 2019 is more than 4.5 million people, which is 3.12% of the population of the Russian Federation. Metabolic disorders in diabetes mellitus cause physicochemical changes, including a violation of acid-base balance (pH). Aim. To study the effect of diabetes mellitus and ocular prosthetics on the acid-base balance of the prosthetic cavity. Materials and methods. From 2018 to 2021 - 185 patients of both sexes from 21 to 80 years old (57.73±17.34 years old) were examined. 47 patients using an eye prosthesis and without diabetes mellitus (group I); 93 patients using an eye prosthesis with diabetes (group II), which were divided into two subgroups depending on the level of glycated hemoglobin (HbA1c): II-a subgroup - 47 patients with HbA1c up to 7.5%, II-b group – 46 patients with HbA1c more than 7.5%; 45 patients, without an eye prosthesis and without diabetes mellitus (group III). Results. In patients with an ocular prosthesis and without diabetes, a shift in pH to the side of acidosis was observed. In patients with an ocular prosthesis and with diabetes mellitus, the greatest shift in the pH of the conjunctival cavity to the side of acidosis, depending on the level of HbA1c (8-8.5 – in 25.8% of cases, 9-9.5 – in 43% of cases, and <10 – in 31.2% of cases). Conclusions. The presence of an ocular prosthesis in the conjunctival cavity leads to a shift in pH to the side of the alkaline side. The progression of the pH shift to the side of acidosis directly depends on the HbA1c level in patients, and the combination of two factors (the use of an ocular prosthesis in the conjunctival cavity and the presence of diabetes in the anamnesis) leads to an aggressive shift in the pH of the conjunctival cavity to the side of acidosis. Key words: acid-base balance, ocular prosthesis, diabetes mellitus.

NEW OPPORTUNITIES IN THE REHABILITATION OF CHILDREN WITH CONGENITAL ANOPHTHALMOS AND MICROPHTHALMOS WITH METHOD OF STEP-BY-STEP PROSTHETICS

Purpose. to present new opportunities in the rehabilitation of children with congenital anophthalmos and microphthalmos with method of step-by-step prosthetics. Material and methods. the analysis of clinical material for 3 years (2015-2017) on the basis of ocular prosthetics office of Moscow Helmholtz Research Institute of Eye Diseases. The clinical group consisted of 155 children: with congenital anophthalmos - 59 patients and microphthalmos - 96 patients (bilateral microphthalmos (9), bilateral anophthalmos (5)). The age of patients ranged from 1 month to 11 years. Under the age of 1 year, there were 82 children (53%). The identified dynamics in the age category of children significantly increased the number of patients under the age of 1 year who were treated for primary ocular prosthetics (53% for 2015-2017. versus 20.2% for 2000, 2013). Results. all 155 patients were treated for dilatation of the conjunctival cavity by the method of step-by-step eye prosthetics. To step eye prosthesis used set increasing in size retail, which can be varied in 3-4 weeks as stretching of soft tissues. In congenital anophthalmos to achieve stable results were performed from three to 6-7 replacement of the eye prosthesis, in congenital microphthalmos, depending on the size of the eye 4-6 replacement of the eye prosthesis. The volume of eye prosthesis used for 3 years increased by 4-5 times, respectively, noted an increase in the size of the conjunctival cavity, eyelids and the size of the orbit. Conclusion. The possibility of frequent and timely replacement of the medical eye prosthesis ensures the gradual formation of an adequate conjunctival cavity, and, accordingly, the development of bone orbit and eyelids. This treatment tactics promotes both functional and cosmetic rehabilitation of patients of early childhood with congenital anophthalmos and microphthalmos.